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Exh 4B
n AGENDA ITEM NO. ~7 ' U Meeting Date: I ~ Z. ~ ~ ~1 CITY OF ATLANTIC BEACH CITY COMMISSION MEETING STAFF REPORT AGENDA ITEM: Bids for Additional Doors in City Hall SUBMITTED BY: Don C. Ford DATE: January 20, 1999 BACKGROUND: In 1997-98, the City installed locking doors and security cameras in the South end of City Hall. This was intended to provide necessary security for that section of the building, which was especially crucial due to the money that is handled by the office staff In 1998-99, the City budgeted funding to add doors to the hallways leading to the North end of the building. The doors will not restrict access.to the City Clerk's Office, but they will assure that people do not simply wander around the building and offices without supervision or direction. This will improve safety and security for city staff and property, and it should improve citizen services by assuring that every citizen will be accompanied by a staff member to see to their needs. Original proposals for this work were just under $3,000, so it was advertised for competitive bids. The lowest bid that complied with all of the bid requirements was Sandbar Construction with a total cost of $3,200. RECOMI~~NDATION: We recommend that the City Commission approve the award of the construction project to Sandbar Construction in the amount of $3,200. ~~ ~~~,,,tiaw~.~ ~ ~~ ATTACHMENTS: Memorandum to David Thompson `~ REVIEWED BY CITY MANAGER: n CITY OF ,rft~!caKtie ~eac~ - ~TGvria~a 800 SEDIINOLE ROAD ATLANTIC BEACH, FLORIDA 32233-5445 TELEPHONE (904) 247-5800 FAX (904) 247-5805 SUNCOhi 852-5800 MEMORANDUM January 19, 1999 TO: David Thompson FROM: Don C. Ford C~ RE: Bids for Additional Doors in City Hall The bid opening for the additional security doors in the City Hall building were opened on January 13th at the Commission Chambers. There were four bids received. ~'`~ The lowest bid was not acceptable due to no original insurance forms supplied with the bid. The bid committee approved accepting the second lowest bid of $3,200 from Sandbar Construction Company. We had received an estimate of $2,975 from Richard Bell prior to bidding the project out. DCF/pah Enclosure/Bid Tabulation Sheet !^~ ~~ ~~, ~ 3 m m O n n O m z N v. r w ro ~ ~ ~ ~ G •o n z ~a c c o H ~ °~ ~ ~~' 0 3 0 ~c " y 8 ~ m ~ ~ m y~o ~ z H y ~ ~ y~ t' ~ r x ~ ~ ~ a0 T ~ H O H ~ m ~p ~ x ~ d C N N H ~ to 9 t" Vf (A ~ m >> ~ 9 ~ o ~~. rr 3 M ~3 ~ O x [~7 ~ M r r-~ c~ ~ r_ r~ N ~ H [s7 o p ~ x a n m ai ~ xr° [*1 ~ H *1 [ ~ ~O7 ' H M < \ ~ z_ W M tC N ..~ N r ~ ? C r ~ m ~ ++ ,., K C ~ r~ ~° m x ~ rN 'o ~ x ~ n m w c c \ ~ z ~ x ~o ~ m ~ ~ m d r ~ ~' Z -O 17 H hf ..~ m m - i ~. y a -c z ~~ ~o o ~ a ~ ? -n ~ ~, m ~ r o 0 m ~ H ~ x ~~ ~y o a ~ f7 N M O t" x m c z zc~~ .p .i b z i*r 0 ~p ., to ~ro m ei~~ N O N w m f i H z ~ :i M M O ~ 37 ,b i ~ m - c z o 0 ~ ~ ~ -° ~ ° m ~ • a m '{ r r 'fl ~ d z w n ~ m e • Ltl.-L7-7ti a~:bk7 r-n r'VKI:MH~..1NG ATLLtNTIC BCIi 9©4 ;2375819 p,p~ IiID N0. 9899-10 - FURNISH A`iD INSTALL TWO SOLID-CORE DOORS A,NA A n _., ~_ HALF-WALL A: NORTH END OF CITY HALL. JOB DESCRIPTION: In^ta11 two {2) new solid core 3' by 7' :lush-counted doers at the north end of the City Hall buildini3. Openings must be franked out with structural grade southern yello,r pine. All lockoets, closers. door stops and trim to match existing. Elsctr»c lock to bQ installed on door at tha Oast side of receptionist desk with a push- button control at the receptionist desk. All doors sad trim will be painted toith a high-gloss enar:el paint to match existing. A half-wall with oak cop to be installed at west side of receptionist disk. TOTAL LUMP SUM PRICE BID TO FURNISH A?vD INSTALL THE DOORS AND HALF-WALL AS DESCRrRF,D ABOVE: ~_ -T~BUJ~wd /'Ii+~~~nclrec~ ~ _S/y[~cr~ ~~ollarr~) SUBMITTAL: v, ~~ ~c~r~n c~~h~ Q _~-tz7~~" ~~s'.J E, ~ rs~; ~ BIDDER ~}/~ ~'o T vim, ~I _ . R1lSiYESS gADRF.SS SIGH URF: CITY. STATE 6 ZIP CODE TITLE DATB:__ ~ /,4-~ ~J, ~~1 7 d~ Z~~ ~SZ.S~ BU6INEbS ELEPHON~~px, CONTACT PERSON:_ V EJH,tI ~,4~,5'O,~I TELEPHONE NUMBER: 2 ~ 7 9S Z S Tr1XPAYER IDENTIFICATION NU:IT~ER (Federal Employer Tdentificatian A'umber OR Social Security fiumbsr): G o~~iD ~~7'~Rc. f},vn P~reso.J,4t_ ~' DEC-29-98 12:30 PM PURCHASIi~G ATLANTIC ECH 9D4 2478819 CITY OF ATLANTIC BEACH DOCUFfENT REQUIR2~'NTS CHECetLIST NA ~ BID Soi'D (if required an Lhis pro3ect). ~~ OP,ICIKAL Insuranoa CartiHcat.e (copies, :eroxea, or facsimiles are UNACCEPTl+3LE), naming the City of Atlantic 8nach as Cortitieato :colder, atioaing they have obtained and will eoatinu~ to carry '~orkerA' Conpensatior., pub?ic and private liability, and property damage insrursnee during Cha 1.ifa of the contract., Three (3) references from corzpanies or individuals for Whore the bidder has completed work or provided A product durinE the past 12 zlonths, of a cocpurab:.c size and nature as th:s project. However, naming the City of Atlantic Beach as a refPZence on bast pro~ecta is UNACCEPTABLE. I ~ ?root of OCCUPATIONAL License (copies ARF. acc4ptable). -"- Bid submitted IN Tc~IPLICATE (thret (3) seta). ~~ Signed copy of Documents Regcireme:tta Checklist. Tire above xequ rernenta have been aotrd and are underRtood by bidder. SIGNED: s~'i:t-s. (Bidder or Agent) DATE: _ ~"'-~3r 99 BID xo. ~~9~-/0 P.04 ~~ '.: ... .. ..:: ~. .. .. S :..:. :. ~ vv: :,> ... , .: ~. .: .. ACORD ::: > '~ :.:, ~ . ~ ~ ,., .~ . . .. •:: nv:: :r v.J ~ :•ii::?y;{.y.::;y.r iii%~i> ti .: i, ~. .;. .... .. :.. ::::. ..:.; .:;: } :DATE MM/D.../~/y ., ;: > . : :.. .::..: ....... :.:..~.:.r :. Y .~y~ ...:.... .:.. ..,.,..x..~ :.::::::.::::::::::........:..... ...:..,.:,... .. SU~f'OC<0.YM%`CAY{Nh^ht\d.~ tltAX3.Kv}mu•~'~YW ,.:.:..... wk s .n.v..vwwv,.xi•..vv.nuvrnvMvnvnwrn•%r.....w:nv.A...iW~.:i : ....: ...... ..,.::.:~ ::.:,.:: ::ro.}. ......::. r•:::::: `i... ~... :: ::: .:.,:..::::.v...:. ~::.~:::• 1/12/99 #'. .::::..i»:.......::{Si:: is>:3i::.. :':w"?:^::Sviiii:3:::::: n•:.:r. _:: n~::::.:r: ::• ........ n ....:.:::.:::.. .................................... r. PRODUCER (904) 280-0424 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE THE DEKINS CORPORATION HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 14444 BEACH BLVD. SUITE 18-116 , KSONVILLE, FL 32250 COMPANIES AFFORDING COVERAGE ~~ ' COMPANY A ASSURANCE COMPANY OF AMERICA INSURED COMPANY JOHN E. PEARSON,Iff DBA g LEGION INSURANCE COMPANY J.E. PEARSON GENERAL CONTRACTOR COMPANY 1416 FOREST AVE . C NEPTUNE BEACH, FL 32266 COMPANY D ... .. ..>. . .......... ... ............ .Y ...:.. .. .... ..... .. .: ...::::: *::lv::.r:.v::: :: ~ :..:.::.........:.::::n~.:~:::.:n:w:•.:,:::.v.:4.:::::::.~::::::.w:::w:.v::::w.::•::•is~~'~:i<iv:ii}~i~>:::.:Y::::?':';:;:}?;:??; :i iii:"! . .........n ........................ ........ n..+..... n.. ......vv................. :.~:: :.:.:..:::.::.: .: :....~ .::: /.ww.nw....nw'.r..wwfl2 GCCrwJ. ,~w w:::•:: .. w~.vnvrvwvnwL~~~w'~.ri.nu.r.:.... .. . . THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED B Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GE NERAL LIABILITY GENERAL AGGREGATE S 1 000 000 A BINDER#011299-01 1/12/99 1/12/00 X COMMERCIALGENERALUAHILITY PROOUCrs-coMProPACC s 1000000 CLAIMS MADE ~ OCCUR PERSONAL 8 ADV INJURY 5 5OO 000 OWNER'S 8 CONTRACTOR'S PROT EACH OCCURRENCE S 5OO 000 FIRE DAMAGE (Any one fire) S 50 000 MEDEXP (Anyone person) S 10,000 AU TOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT S AU. OWNED AUTOS BODILY INJURY 5 SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY S NON-OWNED AUTOS (Par aecidenq PROPERTY DAMAGE I S GARAGE LIABILITY ~ AUi00NLY-EA ACCIDENT 5 ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT 5 AGGREGATE S EXCESS LIABILITY EACH OCCURRENCE S UMBRELLA FORM AGGREGATE S OTHER THAN UMBR0.LA FORM S B WORKER'S COMPENSATION AND BINDER # 011299-02 1/'12/99 1!12/00 X TOR uiaMTS ER EMPLOYERS' LIABILITY EL EACH ACCIDENT S 100 000 TI$ PROPRIETOR! PARTNER° DCECVTNE R1CL 0. DISEASE • POLICY LIMIT S 5OO 000 OFFICERSARE: x EXCL ELDISEASE•EA EMPLOYEE 5 100,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES!SPECIAL ITEMS :...:.::....r..:::.:.~. ....:.. . .. ...v......... .:~ ..n .:.. :K.. ..Q~:~. ..<.~. ...>r r".'vi iv:ryw.iw::...iyv,,:+:}y:.>Y:::.y~.ywi•.. .:; .. ... .. .r ..n. Y~ r.r..... w3%v.4.aK .tea\.Rn.>\.nNn..ur..v.rnx k3..nrvx%....Ln \.vx. A>...>:pM.ir • ••~• ...... ....... .:......:... . ,:.. .. .. .. t~ 4:i<;:.ti:;(::•:L:i2:i:~:~::i~:i?. {: i:'::.<v:'J%i3i:vv.:< ~~. L t~%ii:<i;i;:yiv?:~i>»ii:•>:>:^:i ^iiii:ii S~i+i>~i:'3': iiii>"i: ::. v.::. v:n.:::.v.v.:::::.v:::.::.:vrn:::.:'~•: ...... ...v ............. nv. .::v:.v. ~:... nv.vveer.x3v.~:.w.vr>:)w:J%SKSi>S%~:JaJi:?S~:J:3>iiv:-01U>}>%S::A.>:Sri3:uClti~ri~i:4>::Shy}:ti~i}>%•>ti•i:3:3»ri•»:J:r: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE CITY OF ATLANTIC BEACH EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 850 SEMINOLE RD. 1 ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, ATLANTIC BEACH, FL 32233 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY ~ ( . . :r..r ..., , . ' . . » r~ r ~: AU ORIZED I~PR ENTATIVE t l I ` T~ `4\1' ~--~- ~ ~ y ~,M , ~- ,..,. ~ . ~ yw~ .,~ s~ .;~:,:....,..-~a>;»».~..,;:h;,>~>~;~>~»r~mr:V;;??>..,,>.~: ^%:-~<.~;~h;•»;~.~::^s~xa:?r-r.~rs~z:~;. ...... .. ryii i}>i.....yx..iii>i'~:?:.:w r ..::........:.:..... ... ::.:.::...: ?: •:vN is>:i>:.vnv; ...n. .:..r.~::>:.:.:•::::^:~:..i...•::::•::::.~:•:::...:.. ~..,,,. r ,,, .:~>r..:~ . : . .... ......:.:..•.v:.v.v.::.•• -: ~n :...:. vvn::v::: .v...• ....... :.. .. :. ~(' ;;y :::>::?•»:~::~»:.::?asi:;S:~:»>:::::::~:>:..;..»:~:`>i;:.;i:v:;t:; `..3:.;:`:`Ya:::~i::%?~:.: `.~' :~~~~171~:ii' ~~'i~:. ' i :: •i •.t••:'~•S:1 .ld~••'. `'• -,a~i. trl i 'fit::', :.. t6, rl , .tom,?• .. ~ ;,~t ,t~ti•. :~.'~~.,*''• *i•~•, gym,,. ~ ~ . ~, ~ •~1:.i ..~.: 'L:t'i 1i1 :L •''•'.y~!' (~'. ~ a' ~ Q1 T+1 .fxo R Cj ,. ,-.! • t• :e 's~;:'.~:"rt 'CJ' :G•' , "' 1T (=1 js7 •~, ;'i`ii' ~s Gl H . ;H~.•. ' ~ ~ Sr 'C! ~ • • •'.t.' t V•' :' ~ i • ,,,~,~ P+ ro to ' 4'.N..:K'." ;;~. ;~',1t..:~;L` ~~''' L7 131 i~ ro ~ ~'• ~7 Lr! . t~>~~~'~••'TE~~, •.~iT•.; iie 'k1t,. . ~ e•1 .. '~ Qt ~y .•.1 ta•.-i-m '.t': • '.r:.,~:~:f~'~it' ':~:.1; l ~' ~ r, W'. S Ut ~I 0 ;~. Y Q~.ii~• •1ti ~5~,• ~' il~. 1 • CO _ '~ ~ ::, ..~,.. ~WCp =O .. ~.... ~.: v ~:,~•~, G;Z~,. r• a.M,~` • ~ 4:1~` . ~,~ry1~~ ~y a. ~~+',~r ~ ,^I•',••~•'~ `< •.~X f'•• .I Q ~~1 'tea AV .t `>, • Y.~ ~,j •4 1ji ~•i:-:~~f.. r ~'i. - i~. 4. k,:l ~: : r '; ,~~r~i {~i ~ ?'Fr'y. .I•{ ',~#~,~• ~''iF+~'~~ '.i F •'"'.. 'rl~t~ ray ~' 3 'D y.'kk{`'g1j M r~Y :.,1ClV~('t~1\•. r~~•rx4 r~~ ~ e E ti.4 O ,I' ~ 1+A' ~:.r DEC-29-9r3 12:31 PM PUP.CHASING ATLANTIC BCH 9Oa 2a7~819 P.O~ ~~ W"y Request far Taxpayer ci~e Corm to tt>'e `p"''`'t"`"t0°" Identification Number and CBrti~ication rrqu"`t"' °o "°~ o.,r~:.rw.rtn.Tr..~,y send to the tAS. wror ~....,. a.M.. ,+~ t+tent (tt }ant ntres, ist ttrxt and drW a+t ttmtt of tax versett of ertAy ~M+ose atxeeet Yw u,td r nut 1 Eetar. see ~w~:e~: a i.n i n Yax it:tar tau eTuveer.} ~ tir~rwt none tSd+ aieo+Won w in+tnC.iav 0~ p+4~ 2•I , ~E, .E' R S oiJ ~iV~ R.~L Goit/ T sh.To2 a t-MUlf Ct+Wc lppr+Op/lats tDO~: M~aMdWV5aa p•oarNtM CarPOril~On Partrrran:p Ctnr - ................................ ,r. aaanu E+umotr, avees, and apt. of aw• nos Rpvater'a rurne ind satires (cgt;on~j o ~ f ~ .ES / ~~.~ . t;+y. s~un/~ and LP code /UEPTu/vE ,~ Fu+ttr your TiN In the appevpriate box. !~ mdi~Advalt, this b your reeiat seauty n (SSN). For tote proprietors, see tits irtsi on paQs 2. Far outer ertttCee, tk b your r bentlLdtlon number (Fttv}. tf you do tx number, see Nov 7o Ott a T1N below. Note: KtM etxaxd k h n~torv tMrt ort+ a+s tAe mart orl paga 2 forOu t rxrttDev to ertla/, 1 ClttrfiCStioct ~ t!r-der ppnettiee of perjuy, t herttty that: 1. The nvtrrbsr shown art tlis torte b ttty z tam not twC#ect to to.ctaio vttw,olarry a.reru,e Ser+~ks chat t ant att,Jad to i me inc! I am na fonpar wbjeci to taco c.rtitfatl~an tr+rtruatlota,-You rntsst wiitttotdirtq t»e+uas d tx-dertepor[ing Ltti interest paid, fete aogttts8iort tx t (aUy, and 9erw.alty paymeras t7ttter than Tw. p-ba ese AsK tat kvtructlorts on ptDi Sign ~N.ra S+rlton m/eltflrtcas arv to fY-e Revenue C.odt-. :f~l~ , ~G 3Z Z-ra t Ntxnber t,'rlNj NoT~.: ~jv~E~R~~ i /ten/ bcl TH/S ~~G ~ ~.5 Far Payoei Exempt Prom Backup 1+{fithhoid'my (Sa Part p Inrtrvelions oft paQs ~} ~,S ivo T SvBT~T j b ~ v./~/ L~ ~ i ~- i Ty ~}S nb+r to o. lsawei to m.). u,d ve not boon r+otrsed by the tntertt'af r d;rtd~rtds, or (cJ the IaS tua noWdd w ars wrrertt+y twbject to bscjap t, hem 2 does not apply. For tnatQege n l~tdMduet t't+i1t7rt10nt arranpertwt! }at, but you must pnarida goer oorroct cayrr+ates txdex txttaln cQrtdltlorts. TTt)s Ls t.alled •tottola7p vrtt!'tholdlrlg.' 1'aytn«,ts that eautd be sub(e~ct to bacbwp wttihhotdtrt9 include tnteresL dividends, broker aria txtrtx extxtar~e tt~aCtlorts, rents, tvyattlea, nonsmpioyee pay, artd eerta.'h payments frvrn ttsttutg boat operators. q4a! estate transactfora am not subject to backup withftOtdlrtp. K you ghre the rOqueator your oorrsct '17N, make the proper cxrtttkatksns. and report ad your taxable tntersst anc! d'nridend~ on your !ax return, your paymcYtts wUt not be subject to tuokup witnholdrrtQ. Payments you re~celve wait be trt~(ect 1o baCMup wittthctdtng H: 1, You do eat i,Mtish your TIN to L>e requester, ar 2 The IRS tells the requester that you furnished an tneom;ct YIN, tx ~. The IaS felts you tlut you ars subjet; tc backup withltolCing tsaaat~e you did not report alt yow. interes: and dividends cn your tax return (tor reportable interest a:~a di-rdetxts only), or 4. Yoe ao eat certify to the regvester trot you are not wbjeet to baGwp wltnnadirtq under 3 aeova troy reVOKabte ~~~~~~~ Intorar, ano tSvidand aooourtrs opened crier 19t'3 artly), or S, You do not carttly yotx T1N. tree the Pars to trt~->i~ for escc~.ptsor~. - . ,.:. Ctria!r1 payees and paytttettts ero ~ . exerttpt from bac~s:p wftttttotdlrtQ Bred Information tepotiirsg. Sea the Ptut It . hEtruetlorts and the sOpsrate ltzstrttctlores for ens Rec7uestu of Farm W9. How 7o Opt a Till-•tf you do feet have a TIN, apply act one trrmeciatdy. To apply, pet Form SS-5.1~ttcstSon for a Sodal Sewrfty NvmSer Card (tor individuals). front your local office of aria Sofia! 8eaartty AcfministraGon, or Farm SS-4, Application !or Employer ldenG6estlon Number (!or tst~inesaes and a-I other enGl)tu), horn your local las a!6ce. If you do not t1ave a TiN, wttte `Apptled For' h the space for t:te T1N In Dart i, sign and dato the form, and gtre Ii to rie requester, Gsnsraty, you vrtU then hew t30 drys to get a TtN and give it to the requester. if tn. rsquester boss not receive yotx T1N wllhln ti0 tssys, backup witfthciding, !t atSpUcabl0, wiU t,es}in and continuo unfit you ttrmish your TTN:• _ A,spaa+ of Fours.-.+~ Person who b nequirod to the ere hfannnticrt rotturt wtt't fete IaS mt.sst pet your cart+et.Y TIN to report tr+corrte paid to you, rea! estato trartsac~)ons, rrtortpapa htttttast you )sake, the acgttlsitfeort or abarldorvttertt at se~,.tr«t property, eanadution of debt, or :ontritw9ons yrw made to stn t)~. Uso =one W9 to pew your eorreo! 71N to the ~auestar (a'1e person reques~rtg Y~'nM end. when atpdk:able. (t) to aartty !!,e ttN rov are pititrtg b corroct (or you are wafting er a number to be tssusd), (Zy t0 urtfty wu an not wbjact to backup w(thttOldit'tg. r (3} to ctum exemption from backup +imndding it you ars an tzert,pt payw. living your CorrCCt 7IN and making the ppropriate cerlifiCetions wlG prevent Brute payments from being subject to ackup w;tt;hotding, ors: H a reCWesler Qi-eS ycu a form other tan a Yy9 to rt*quest your T7N, you must a the roquesrers loan tt K is stlbirantlarty miLr to Utts form W9. Tut is Backup Withholaingy~sersons eking certain paymerrttx to you rrtu:t thhota snd pay tc the tits 3155 of ouch L1at toaxxR nvnt»rrst Mn (eotkw~q J~ 17 Form W-9 tA.~. ~•f•tl ~\ , BID N0. 9899-10 - FURNISH AND INSTALL TWO SOLID-CORE DOORS AND A HALF-WALL AT NORTH END OF CITY HALL. JOB DESCRIPTION: Install two (2) new solid core 3' by 7' flush-mounted doors at the north end of the City Hall building. Openings must be framed out with structural grade southern yellow pine. All locksets, closers, door stops and trim to match existing. Electric lock to be installed on door at the east side of receptionist desk with a push- button control at the receptionist desk. All doors and trim will be painted with a high-gloss enamel paint to match existing. A half-wall with~oak top to be installed at west side of receptionist desk. TOTAL LUMP SUM PRICE BID TO FURNISH AND INSTALL THE DOORS AND HALF-WALL AS DESCRIBED ABOVE: l ~Q-~ i~- l~D~~"`'~ lu`-~ o ~ `n c~Jl-tom ~ (Dollars) SUBMITTAL: c`~~~~r°d~ ~ns-~~c~C"ic0~ BIDDER BY `~~~~~ tom. © . ~©~. '~tOO~j Z- BUSINESS ADDRESS SIGNATURE CITY, STATE & ZIP CODE TITLE DATE: ~ `- l3-' ~~} ~9~~ '2s~-Z _ ~1~ BUSINESS TELEPHONE CONTACT PERSON: ~~ t~~ C~~c ~~ TELEPHONE NUMBER: ~-Z- ~ lQ7 -~ ~~ 3~j~'-ZSZ 5 _C~~'~'9~ -~9 S~Q TAXPAYER IDENTIFICATION NUMBER (Federal Employer Identification Number OR Social Security Number): ~~~-~?- 4oZ ~ f ' W ~ ~ ~ O CO Z O 1 W °` U J ~ O w M ~ ~ Z ~ N a O 0 U Q W ~ m ~ ~ W W a J ~ o ~ ~ Z ~ i ~ z w Y..m >J Z rC O O V U V THIS LICENSE GOES NOT PERMR 7HE HOLDER TO OPERATE IN V10LATION , Of ANY CITY LAW OR ORDINANCE T W a, ,^ , V/ .r m Z ~ O` W a . ~ U a o .» - J ~, a \ a_ ' ~ J 1 a ~ a0 o~ { ~ ' tii a Z O~ ^' ~ O O M , N. ~ ~ }~ J n ~ Z a i a ~ ~ Z a Q ~ _ ~~ ~ _ o m m ~, U a N > . °~ V a ~ o W v~ w = Z ~ p x Z W _ o: ~ w o ~ w c 0 o u ~' ° o -- a ' z a o ~- cn , o: ~ O W o ~ F- F+ N O Z Ln N N ., ~ . . U : O O N N V Z N ~"1 v 4. \ Y7 Z O J ~- J O • F-Z tL Z W ~ J Z O W O ~ Q W 7 -' F- Z O W -+ F- = N rnoOU o a W' w a ~ w w ~ uNm N ' O Z -+ w Z N W U' O O lL ~ W O M J --I • Z lt. O J u O J Cn W O O TL J O ~"~ ~ N \ -~ O: to N u Y ~ Q u Q Z tq X O O O O O N O m N Z T°f u Q O Q wona .+=N7L wa -~,,, ' ` ~\Q~~dc 4~ Z v J o ~~' ~ N ~ o .w W N 2 Q N ~ ~"~~ fu`s` m v N ACORD CERTIFICATE OF LIABILITY INSURANCESSR RR DATE(M6UDNYyj ANDS-1 01/12/99 PRODUCER THIS CERTIFICATE tS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE illegass Wilson S Cowan, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ~15 North Third Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Jacksonville Beach EZ 32250 Phone:904-249-5667 Fax:904-246-1566 INSURERS AFFORDING COVERAGE INSURED INSURER A: Assurance Com an of America INSURER B: Sandbar Construction David B , COX dba INSURER C: P O BOX 5003 INSURER D: Jacksonville Beach FL 32250 INSURER E: L V V tKACitS THE POLICIES OF INSURANCE LISTED BELOW NAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTYlITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT OYITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY FU1VE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE POLICY NUMBER DATE (h1hUDOm GATE MtiUODlYY LIMITS GENERAL LIABILITY EACH OCCURRENCE x 3 0 0 O O O A X COMMERCIAL GENERAL LIABILITY SCP 32423031 01/14/99 O1/14/OO FIRE DAMAGE (Any one fire) a 50 OOO CLAIMS MADE ~ OCCUR MED EXP (Any one person) S 1 O O O 0 PERSONALdADV1NJURY S 3OO OOO GENERAL AGGREGATE a 600 OOO GENLAGGREGATELIMRAPPLIESPER: PRODUCTS-COMPlOPAGG S 6OO OOO POLICY jE~ LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) S ALL OWNED AUTOS BODILYIWURY SCHEDULED AUTOS (Per person) S HIRED AUTOS BODILY INJURY NON-0WNEO AUTOS (Per accident) S PROPERTYOAMAGE (Per accident) S GARAGE LU181LITY AUTO ONLY - EA ACCIDENT S ANY AUTO OTHER THAN ~ ACC 3 AUTO ONLY: AGG S EXCESS LIABILITY - EACH OCCURRENCE 3 OCCUR ~ CLAIMS MADE AGGREGATE S S oEDUCTIeLE s RETENTION S S WORKERS COMPENSATION AND MP ' TORY LIMITS ER- E LOYERS L4481LITY E.L EACH ACCIDENT S E.L. DISEASE - EA EMPLOYE S E.L. DISEASE -POLICY LIMIT S OTHER l vv..,. •,v,.vr rLMIIV.\JILVN111VI~~lIYCr1,VLCJI f:/\VLVJiV1YJH000V Or C1VWRJCM1ICIV I/.~F'CI,IAL YItUViJIUryJ Concrete Construction CERTIFICATE HOLDER N ADDITIONAL INSURED; INSURER LETTER: CANCELLATION CITYATI, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1 O GAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED 70 THE City of Atlantic Beach LEFT, BUT FAILURE TO DO SO SHALL Ih1POSE NO OBLIGATION OR LIABILITY OF 800 Seminole Road Atlantic Beach FL 32233 ANY KIND UPON THE INSURER, ITS AGENT OR REPRESENTATIVES. ACORD 25-S (7/97) " ACORD CORPORATION 1988 CITY OF ATLANTIC BEAC'd ~, DOCU"cD;NT REQUIP.~NTS CHECKLIST NA gID BOi~i '(if required on this project). J OP.IGINAL Insurance Certificates (copies, 4eroxes, or facsimiles are U:tACCEPTA3LE), naming the City of ~.tlantic Bezch as Certificate Holder, showing they have obtained and will continue to carry 'Aorkers' Compensation, public and private liability, and property daaage insurance during the life of the contract. III Three (3) references from companies or individuals for whoa the bidder has co^~pleted work or provided . a product during the past 12 months, of a comparZble size and nature as this project. However, naming the City of Atlantic Beach as a reference on past projects is INACCEPTABLE. Froof of OCCUPATIONAL License (copies_ARE acceptable). Bid submitted IN TRIPLICATE (three (3).sets). Signed copy of Docurients Requirements Checklist. _ The above requirements have been noted and are understood ~y bidder. SIGNED: ~ (Bidder.or Agent) DATE : /- / .3 '- ~ g BID xo. ~Bq9 - i0 ~~ BID N0. 9899-10 - FURNISH AND INSTALL TWO SOLID-CORE DOORS AND A HALF-WALL AT NORTH END OF CITY HALL. JOB DESCRIPTION: Install two (2) new solid core 3' by 7' flush-mounted doors at the north end of the City Hall building. Openings must be framed out with structural grade southern yellow pine. All locksets, closers, door stops and trim to match existing. Electric lock to be installed on door at the east side of receptionist desk with a push- button control at the receptionist desk. All doors and trim will be painted with a high-gloss enamel paint to match existing. A half-wall with~oak top to be installed at west side of receptionist desk. TOTAL LUMP SUM PRICE BID TO FURNISH AND INSTALL THE DOORS AND HALF-WALL AS DESCRIBED ABOVE: ~ ~2 25 4 7_;~lni ~ r1~'~U,S~Q 7"w~ /~Nn/~~ ~cU~~l ' ~j l/~ (Dollars) SUBMITTAL: ~r ~r•~ /3~2- r BIDDER ~j~~~LDfN6 <OtiT/1~t~v ~- _ /~,,~z brA~fJSi fl~ cT BUSINESS ADDRESS ~1~~r~?~~ ~~~k~~3 ZZ ~3 CITY, STATE & ZIP CODE • DATE: ~ 9 BY /~~~~ ~3r ~~ • .: ,~ NATURE °%~~ TITLE 9~~ ~~~1 v~~~l BUSINESS TELEPHONE CONTACT PERSON: ~~1'L'a-yG1 ~~ TELEPHONE NUMBER: 7~'q O /'i~ TAXPAYER IDENTIFICATION NUMBER (Federal Employer Identification Number OR Social Security Number): S9 ..~.Sa6 7 ¢.~ ~. CITY OF ATLANTIC BEAC'd DOCUr~.*IT REQUIP~NTS CftEC'cCLIST l1/A BID BOini '(if required on this project). J OP.IGINAL Insurance Certificates (copies, ~erores, or facsimiles are U:QACCEPTABLE)~ naming the City of Atlantic Beach as Certificate Holder, Showing they have obtained and will. continue to carry 'rTorkers' Compensation, public and private liability, and property daaage insurance during the life of the contract. Three (3) references from companies or individuals for whom the bidder has co:~pleted work or provided - a product during the past 12 nonths, of a comparable size and nature as this project. However, naming the City of Atlantic Beach as a reference on past projects is UNACCEPTABLE. • ~ i?roof of .:. OCCUPATIONAL License (copies-ARE acceptable). Bid submitted IN TRLPLICATE (three (3)•sets). Signed copy of Docurients ReQui=ements Checklist. •. . The above requirements have been noted and are understood by bidder. SIGNED: (Bidder or Agent) DAT:.: BID N0. g 6 `j% - //~ ~' • r~e~{ucat. tut tdxNiayer Give form to the `~"'' """~'~`' (dentifcation Number and Certification requester: Do NOT ~~~~»*w TS~ send to the f RS. ltrme (ll.joa~ runes, ist frst and ardc the rurtK of 1tx puson a eruay wAost nrmt+er you entu in Put I txbw, see katnrctlasr oe page 2 If Your acme hss tbatsgeQ.) ~~ o ~~~ Bui~ncss rnme Isere proprier«s see irutrvcr;ons «~ pa9e 2a 0 i'ce` ~y Please check appropriate Go~c lndividuatr$ote Droprielor ^ Corporation Part ^ her r ^ nersh:p of ---------------------- r°, Address (++urnber. sVeet, and ap or wire r+oa .-•-_--... ~ ~< ~ L ~ ~ ~ ~/~~ `~ Requester's tome and address (optionaQ v a stela and 71P code Taxpayer Ident~cation Number Enter your TiN in the appropriate box. For indAriduats, this is yotn soda! seaaity number (SSN). For sofa proprietors, see the irtstrtlctions on page 2 For other entities, It is your employer Identification number (E7f~. N you do not have a number. see How To Get a TIN below. Note: !f the eaaorrrrt is In trlor:r than one name, see the eAarf on page 2 lorguidelines on whose number to easier. 22 Soetal s+a+rfty nut+ber oa Employer fdent!ligtlOri txniber 5~125~~ G~9`• lht acoourrt nurnba(sI here (optionaA For Payees Exempt From Backup {flfrthhoiding (See Part ti instrudiorts on pale 2} Uncle{ penalties of P~lurY. 1 ce*t+fY that: 7. The number shown on this form (s mY carrel taxpayer identification number (or I am watttng for a number to be issued to me), and 2. I am not subject to k>acS¢rp withholding because: (a) ! am exempt from badaip withhddutg, a (bj 1 have not been notified try the Internet Revenue Service that t am strbjec! to backup withhoding az a result of a falure to report atI interest or dividends, or (c) the IRS has notified me that t am no longer subject to haclarp withhoding. Certification trsstruetiorss.-You must cross ocrt item 2 atwve if you have tx~ert notified by the IRS that you are eumentty subj©ct to bac3asp w'rthlwiding because o! underreporting inrterest or dividends on your taz return. For Yea! estate transadiorts, item 2 does not apply. For mortgage intcxssi paid. the acqu'csition a abandocvneni of sectxed propeYty, cancetlattort of debt, contn'btrliorts 20 an Individual retirwtxxd arrangemectf Or'~11. and 9~IY payrttertLs other thm interest and dividends, you ur,a not rtjquired to sign the Certification, but yotr must pnxnde your correct 71H. (Arco see part tit ktsttvctiotts on pogo 2.j !n acre Signature F Oate -~ Section raPerer~ces art3 to the lrrtemal Revenue Code. Pcrpose of Form.-•,A person who is -raquirod to file 8n kt{ormation return wish tt>a IRS must get your corre~et T1N to report Income paid to you, teat estate transacSorts,, mortgage interest you paid, the acquisition or abandorunent of secured Property, cancellation of debt, or contributions you made 20 an 1RA. Use Form W-9 to give your correct 7iN to the requester (tile person requesting your 71t~} and. when applicable, (t) to certify the 71N you are giving is correct (or you are waiting for a number to be iissr.ted), (2) do certify you are not subject to backup withholding, or (3) to claim exemption from backup withholding if you are an exempt payee. 3iving your correct TIN and making the appropriate certifications will prevent pertain payments from being subject to backup withholding. Note: // a requester gives you a form other hen a W-9 to request your T/N, you must rse the requesters form if it is substarrtia!!y :iirniiar to this Form W-9. Khat 1s backup Withholding?-Persons raici~ig certain payments to you must ~ •Id and pay to the IRS 3196 of such payments trader certain eondrtiorts. This is called `badatp withholding "Payments that could be.sut~ject to badatp • witftholdulg include interest, dividends, ~broket and barter exdiange transactions, rents, royalties, nonempfoyes pay, and certain payments from fishing boat operators. Real estate transacttorts are not subject to backup wtthttotcfing. K you give the requester your correct T1N, make the proper certifications, and report art;your taxable interest and dvdends on your tax return, your payments will not be subject to backup withholdng..Payments you receive wilt be subject to badtup withholding if: 1. You do not furnish your TIN to the requester, or 2 The !RS felts the requester that you furnished an incorrect TIN, or 3. The IRS tells you 2ttat you are subject to backup withholding because you did not report all your interest and dividends on ' your tax return (for reportable interest and dividends only), or d. You do not certify to the requester that you are not subject to backup withholdng under 3 above (for reportable interest and dividend accounts opened after '1983 only), or 5. You do not ~fY your TiN. See tfte Para lit instructions for ~-", ^ Cerialn payees and payrnettts are ~ ..~ exempt from badaup withhoding and infomzationreporting. See the part II , instructions and the separate Instructions tot the Requester of F ~. ' How To Get a TiN.--If you do not have a TiN, apply for one Immedatefy. to apply, get Form SSS, Application for a Soria! Security Number Card {for indcviduais), from your focal office of the Social Security. Administration, or Form SS-4, Application for Employer Identification Number (for businesses and all other entities), from your focal 1RS office. If you do not have a TiN, write "Applied For" in the space for the TiN In Part 1, sign and date the form, and give it to the requester. Generally, you will then have 60 days to get a TIN and give it to the requester. If the requester does not receive your T1N within fi0 days, taadwp withhold'utg, if applicable, will begin and continue unfit you famish your T1Nr 17 Form w-9 (Rev. 3-92) ' r,l.c :~LO.~.b:11Z5 `Named belowLDISGCE Under the provisions of Ch Expiration date: AUG DELL, RICHARD ALL INDIVIDUAL 1952 BEACHSIDE CT ATLANTIC BCH LAWTON CHILES GOVERNOR 7=..: t 1. ~., S, . ~1:~ tf:y fr~... ~ ~. .j.. '~i., ..it!.~ >i 'X-~ Fyn, , i ,~,~ +: ' ~ _: ,r f ~' :Y f ~•ii•~ ~ - •:~ f•'• .,S i r~riY{r~~C;.4'L: . .:.., ~ . ,. : ,'.,t'. . ~~ . ~,'1•t 7.1{~"~ ~' ` ~'0.~1•~ 't4~ ' 7'aj.!~ f. • ~ :~ ~ j.'~ . ~ ~ fiit~, -ri`y CL f't~~ Y~ rl~;\' ~ '{'334~1•i Qi~~b r;ctY is t9 f~1 ~_ :. ;. • ~ f•!; ;~ . e; ~...~'I FL 32233-9955 F'. .. _., . • ._ ... •.. _,,` . . .. ... .~I'. DISPLAY AS REQUIRED BY LAW RICHARD T. FARRELL ~.j. .-:SECRETARY ~~. CITY of LICENSE NUMBER ""~~ G ~e GLGl2 '" ~ed~rG~ TzZ`~~~~Z tC ' = f ' > 9 9 D 3 9 04 • OCCUPATIONAL LICENSE TYPE LICENSE: BUILDING •CONTRACTOR•=FIRM/CORP:.-- LICENSE YEAR ~ 1998=1999 ~o~ e u P040 m r ~ " 1952 BEACHSIDE CT CLASS NO. 9/23/98 ~ oon E3USINESS LOCATION DATE ISSUED 9/30/ 99 ~ p `u DATE EXPIRES oz, m n RICHARD BELL BUILDG CONTRACTOR •4T.:00 o~~ z~~ ~ FIE,... ,DAME: LICENSE FEE g z BELL, 'RICHARD INVESTIGATIVE FEE m o ~ OWNER/MGR: TRANSFER FEE ~ ~ '195?_ BEACHSIDE C 0 U RT DEL PENAL ~47 ~, 13 te: ~~24/98 81 Recei ~t ~~'1$5g ToT~~ 0 ~ z s AooRESS: ATLANTIC BEACH • ' FL 32233 ~ ~KS 4831 NOT ~Ile~l~VAIIDATEO BELOW °" / c. ~•-£" Z ? CITY CLERK i • TH S LICENSE h~UST BE CONSPICUOUSLY POSTED IN PLACE OF BUSINESS ---------..----...--- -- ~1 ---•---------••- ~ -•---•-•- -----.._~.__.. .---- - ..__.... ---•._ - SS3NISf1S ~O 30t/'ld NI 031SOd 1~7SnOf101dSN00 381SnW 3SN3011 SIH ~ 31OAll~ 2JO1DV1t1NOD 9Nlalifle r} ^~~~ w >• F=-¢ ~ M0~39031YOIlYA$I}~I+I~3~BQ~I~e~lO~~ ££ZZ£ 7~ HD1f38.DIlNdlld ~SSadC ~o I£B4 5~~101 a~a /4Z/6 a} .12If100 3QISHDV38 Z56L: ~ z I9EF~ ~Ldt H IB 86 Allt/Nad •l3a -- o aad aadSNVal b Z U ~ a3d aAl1tl~JIlSaAN1 w ~ a fl0' },£ 33d aSN3011 z o¢o w ¢ Sa~lIdX3 alb'0 N o ¢ . bb/0£/6 O3nssl alga 3 86/£Z/b •oN ssv-10 w SL9d. ~`~',~ ~ 666E-866L : 1:IVa~aSN3Dil 856£0-b6 Fl38WnN 3SN3CIl N377d • aadH3I21.:..'"i738 • :aowraaN :aWdN N 2101D1lN1NOD ~9Q7I[18.'.7738:.a2it/H3I21' NOllt/DOl SS3Ni 10:3QISHDTl38;ZS15L :aSN30il E • 71lNOISS330Ild; Sf103N.11:'}730SIW 3SN3017 7t'lNOllt/df1000 27~'~iD~~ - i~a~i ~Y ~~'~~~ ~o uIo 1998-'1999 OCCUPAT ~ ORiAL !. ~ CENS~ TAX LYNWOOD ROBERTS ('~~ OFFICE OF THE TAX COLLECTOR CITY OF JACKSONVILLE and/or COUNTY OF DUVAL, FLORIDA 231 EAST FORSYTH STREET ROOM 130, JACKSONVILLE, fl 32202 PHONE: (9041630-2080 FAX: (9041630.1432 Note - A penalty is Imposed for (allure to keep this license exhibited conspicuously at your establishment or place of business. This license is lurnished in pursuance of chapter 770.772 City ordinance codes. BELL, RICHARD ALLEN 1952 BEACHSIDE CT ATLANTIC BCH, FL 32233-2611 09 ACC9UNT ~IUMBER;__004174-0000 ~ __ LOCATION ADDRESS: 1952 SEACHSIOE CT 32233-2611 DESCRIPTION: QUALIFYING AGENT, CONTRACTORS County License Code: 770.000-005 County Tax: N/A ~,,~ Municipal License Code: 772.325 Municipai Tax: $100.00 ( Total Tax Paid: $100.00 VALID FROM OCTOBER 1, 1998 TO SEPTEMBER 30, 1999 ti RCPT ~: QO1T006808 DATE: 8/19/1998 AMT: $100.00 ATTERlT101U ~`**The Following Construction Contractors Require Additional Licensure"** ALARM RESIDENTIAL ELECTRICAL MECHANICAL GENERAL UNDERGROUND UTILITY REFRIGERATION POOL BUILDING SHEET METAL PLUMBING CARPENTRY HEATING ALUMINUM/VINYL ROOFING SOLAR IRRIGATION WATER TREATMENT AIR CONDITIONING This {s an occupational license tsx only. It does not permit the licensee to violate any existing regulatory or zoning laws of the County or City. /~'~~ Not does It exempt the licensee Irom any other license or permit required by law. This is not a certification of the licensee's qualification. TAX COLLECTOR THIS BECOMES A RECEIPT AFTER VALIDATION • ~ Y v ~.i '~.I M v ~/ ~.I' V r.a• +ir `~r• r •, ' r r Y ~i r i.l ~ ~...... ...~ Y r+ .. Ja ....n Ii.. i / • r ~. LYNWOOD ROBERTS ~` 4 . OFFICE OF THE TAX COLLECTOR CITY OF JACKSONVILLE and/or COUNTY OF DUVAL, FLORIDA 231 EAST FORSYTH STREET ROOM 130, JACKSONVIIIE, FL 32202 PHONE: 1904)630.2080 FAX: (90416]0.14]2 Note - A penalty is imposed for leiture to keep this license exhibited eonspleuously 6t your establishment or place of business. This license is furnished in pursuance of chapter 770.772 City ordinance codes. BELL, RICHARD ALLEN 09 1952 BEACHSIDE C7 ATLANTIC BCH, FL 32233 ACCOUNT NUMBER: 068248-0000-2 LOCATION ADDRESS: 1952 BEACHSIDE CT 32233 DESCRIPTION: CONTRACTOR. ALL TYPES ., ` ., County License Code: 770.307-001 County Tax: Municipal License Code: N/A Municipal Tax: Total Tax Paid: $11.25 N/A $11.25 VALID FROM OCTOBER 1, 1998 TO SEPTEMBER 30, 19gg RCPT #: OO1T006809 DATE: ,8/19/1998 AMT: $11.25 ATTENTION *"*The Following Construction Contractors Require Additional Licensure*** ALARM RESIDENTIAL ELECTRICAL MECHANICAL GENERAL UNDERGROUND UTILITY REFRIGERATION POOL BUILDING SHEET METAL PLUMBING CARPENTRY HEATING ALUMINUM/VINYL ROOFING SOLAR IRRIGATION WATER TREATMENT AIR CONDITIONING This is an occupational license tax only. It does not permit the licensee to violate any existing regulatory or zoning laws of the County or City. Nor does it exempt the licensee Irom any other license or permit required by law. This is not a eertilleation of the licensee's qualification. l TAX COLLECTOR THIS BECOMES A RECEIPT AFTER VALIDATION ACORD CERTIFICATE OF LIABILITY INSURANC~PID CO DATE(MM/Op/YY) ELLR-1 01/07/99 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Greene-Fad 11 & Associates, Inc . ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE O Drawer 10209 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ~~01 Riverplace Blvd, Ste 2300 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. acksonville FL 32207 Phones 904-398-1234 Fax:904~396-7432 INSURERS AFFORDING COVERAGE Richard Sell Building Contract Mr. Richard Sell 1952 B achside Court Atlant~c Beach FL 32233 INSURER A: Kemper National Insurance INSURER B: INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. N07WITHSTANDING ANY REQUIREMENT, TERM OR CONDRION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR h1AY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS ANO CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE POLICY NUMBER DATE M GATE MM/DD/W LIMITS GENERAL L41BIL1'iY EACH OCCURRENCE S COhIMERCNI GENERAL LIABILITY FIRE DAMAGE (Anyone fire) S CLAIMS MADE ~ OCCUR MED EXP (Any one person) S PERSONAL d ADV INJURY S GENERAL AGGREGATE S GEN'L AGGREGATE LIMB APPLIES PER: PRODUCTS • COMP/OP AGG S POLICY jECOT- LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) S ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) S HIRED AUTOS BODILY INJURY .~ NON-0WNEO AUTOS (Per accdent) S PROPERTY DAMAGE (Per accident) S GARAGELWBILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHERTHAN EA ACC S AUTO ONLY: AGG S EXCESS LWBILITY EACH OCCURRENCE S OCCUR ~ CLAIMS MADE ' AGGREGATE S S DEDUCTIBLE S RETENTION S S WORKERS COMPENSATION AND X TORY LIMITS ER- A EAIPLOYERS'LIABILITY 38601626700 03/01/98 03/01/99 E.L. EACH ACCIDENT S 100, 000 E.L. DISEASE-EA EMPLOYE S 100, 000 E.L. DISEASE-POLICYLIMR S 500,000 OTHER utacnir ~ wn yr vrtrtn I wnsrwr~ I Iunsrvtnic~t~rtrc~wa~una nuutu a r tnwrcatmtn I rsrtcwL rrcuw5luns CERTIFICATE HOLDER ADDITIONAL INSURED; INSURER LETTER: City of Atlantic Beach Building Dept. Attn: Pat Harris ~ 247 5877 800 Seminole Road Atlantic Beach FL 32233 ATLANTI CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURERjjWILL ENDEAVORTO 1~1AIL L1~AILURE OEDO OLL IMPOSE NO~B~!GATOION R NLIABIDLITY OFE ANY KI PON THE INSURER R AGENTS OR R P ESENTAT~ ~-~Wlx.Oa ~C~ Theresa Greene Haz ACORD 25-S 1,7/97) - ACORD Data remo•;ed during 6.0 to 6.1 upgrade. [10/l6/98] ~orker~s Comp and Smployer~s Liability Section The proprietor/partners/executive officers are EXCLIIDSD CERTIFICATE OF INSURANCE This certifies that ®STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois ^ STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois ~jures the following policyholder for the coverages indicated below: Name of policyholder Bell, Richard A. DBA Richard Bell Building Contractor Address of policyholder 1952 Beachside Court Atlantic Beach, FL 32233-5955 Location of operations Florida Description of operations The polices listed below have been issued to the policyholder for the policy periods shown. The insurance described in these policies is suhiart to alt tha terms pYr•.lusiens and conditions of these eeiicies_ The limits of liability shown may have been redUCed bV anV Da(d claims. POLICY PERIOD LIMFfS OF LIAt31UTY POLICY NUMBER TYPE OF INSURANCE Effective Date Ex iration Date at inni of Comprehensive BODILY INJURY AND 98-t1J'-4335-3 Business Liabil~ 07/05/98 07/05/99 PROPERTY DAMAGE This insurance indudes: ®Products -Completed Operations ~ Contradua! Liability ® Underground Hazard Coverage Each Occurrence $ 3 0 0 0 0 0 ®Personal Injury ^ Advertising Injury General Aggregate $ F00000 ^ Explosion Hazard Coverage Products -Completed ^ Collapse Hazard Coverage Operations Aggregate $ 600000 ^ General Aggregate Limit applies to each project 1 EXCESS LIABILITY POLICY PERIOD BODILY INJURY AND PROPERTY DAMAGE Effective Date Ex iration Date (Combined Single Limit) ^ Umbrella Each Occurrence $ ^ Other A r ate $ Part 1 STATUTORY Part 2 BODILY INJURY Workers' Compensation , and Employers Liability Each Accident ~ $ Disease Each Employee $ Disease - Polic Limit $ POLICY NUMBER TYPE OF INSURANCE POLICY PERIOD Effective Date Ex iration Date LIMITS OF LIABILITY at inni of li riod If any of the described policies are canceled before «s expiration date, State Farm wil(try to mail a written notice to the certificate holder days before cancellation. If, however, we fail to mail such notice, no obligation or liability will be imposed on State Farm or fts agents or representatives. Name and Address of Certificate Holder City of Atlantic Beach 800 Seminole Road Atlantic Beach, FL 32233 ~' 558-99d a 2~0 Printed in U.SA Signature of~A~u/thorized Representative Title D ~/07/~ - oats ItID N0. 9699-10 -FURNISH AND INSTALL rV0 SOLID-COaE D00&S AND A ~, ___ _ _ , ,___^__ HALF-VALE Ai NORTH END OF CITY HALL. JOS DESCRIPTION: Inotell tvo (2) new :solid core 3' by 7' fluoh-mounted aonrn ~t the north enei of the i,sty Hall bu~ldisaS. Op•ntnge MuNe. Lsr 1SHIArt1 UUL Viill ri~tUt,~llt~li ~L1tY~ BVYLllsiu ~ICiiWr pine. %111 iv~.wac~o~ 4avstca~ ciNJ~ scups ~lll~i ZZ1A LO IDQLGhr dilibtiGg. Ela:.tzic iCLw t:% 'r+t i i.w~wi.ii~ ui• 33u~ .ice ~i.~ Gii~ i~.'~G vi iC~.r. ~'St~~i.~4- .~i.~,.Sl 4~~4 ~• •"..4_ ~ -.... L::tt~r. cc..tta: a: the :ecept:atz:sC deck. A!3 dooz~ any tr±- c~riZl ~e F_i~:za aiih ^. ?:±gh-gl:s4 e::a:~e? rsint t~ Ta:eh ~xl4tirg A hAli-•wall vf~F~ nNt, rn~ t~ he 1rt~tAlled ~t we9t sid• .+f rts-~prinn~~t deRk. TOTAL LUHP SUM PRICE >SZD TO lURNISH AND INSTALL ?HE DOORS AND HALT-WALL AS DESCRIBED AAOVE: / ^^nn //'~~'G ' ~ ( / ~~~~~~ r%~.~.f ~~~, ollara) S UbKI 1'TAL ~~~ ~~t~'lc~t°i2s~ ~1~IC r sY /~iVf~lr%y ~~ /~~E~ 6IOOER ~.-~ acv ~~ ' ~ . CAS ~F: S ADDRESS IGNA:URE .,.,,,_ ~C6'C'u~SoNcli//~° !`" t ~ Wit- j~,~ f%S~ `o~c'iv CITY. STATE 6 zIP ODE TITLE DATE:..__ ~ ~/ ~ ~~ ~ /Oc~ lS~~ SiTSINESS TELEPHO.i& CONTACT PEitSON: ~~9/t' ~, ~~F~. TELEPHONE NUMSE3t; /~~ ~5~~ laxrnrtR InENTIFICATION NUMRER (roderel Ernploynr Tdentific:tion Number UK Social Secusit :lumber): ~ ~3~~a~~ ~~ yVV iI IV •i. ~J . .. . VI\VI.I. ~I ~..V I'.. .ter.... ~./ yV1. /V`~ i".I VV~ NAI 0 D CITY OF ATLANTIC BEACH DOCUlD;NT REQUiRY2WNTS CHECKLIST BID BOi~T7t {if required on this pro)ect) . ORIGI27AL Zasurance Certificates (copies, .':eroxes. or facsiatiss are U.L•ACCEPTAELE), aasiag the City a: Atlazttc Beach as Certiticste ~3older, s!sosdrg Lhey have obtained and wi3.? conti~e~,;^ to carry Norkers' Connenearion, pub~i.r and rrivaCP liability, gnd property @ae-age ~ntUT~nco during the lifer Qf the contract. Threo (3) references troy coapanies or individuals for whom the bidder has completed work or provided ++ product during the past 12 oanths, of a compErable vise and :taturo as this pro~act. However. Waning the City of Atlantic Beach as a reference on past projectY is ii~iACCEFTABLE. Proof o! OCCL'PATIO:iA:. Licence (copier ARE acceytable). Bid submitted IN TRIPLICATE (three l3) setB). Signed copy of Docunente Requirements Checklist. T'he above reQuirrmenta have been noted snd are underctood by bidder. SIGNED: ~C~L-~~ :[~L,,.. ~' [ ..c . (Bidder~or Agant) DATE : _~ // 9 BID N0. f . V `- ~' " 1998-1999 OCCUPAT ~ C)NAL L ! CENSE TAX LYNWOOD ROBERTS OFFICE OF THE TAX COLLECTOR ` CITY OF JACKSONVILLE and/or COUNTY OF DUVAL, FLORIDA 271 EAST fORSYTH STREET ROOM 170, JACKSONVILLE, FL 72202 PHONE: (904)830.2080 FAX: (904)670-1472 Note A penalty rs imposeC.tor failure to keep this license exhibited Conspicuously et your sstsbllshment or place of Ousiness. This license is furnished in pursuance of chapter 770.772 City ordinance codes. PEEL BUILDERS, INC 04 FRANK PEEL PEDDLER OF SERVICE 437 HAWAIIAN TE JACKSONVILLE. FL 32218-8114 ACCOUNT NUMBER: 027791-0000-4 LOCAT I ON ~ AbORE55: 37 HAWAIIAN TE ~ ~-~ ` ~ "' " "" -'~'-" - "-' 32216-9114 DESCRIPTION: CONTRACTOR. ALL TYPES County License Code: 770.307-001 County Tax: $11.25 Municipal License Code: 772.309 Municipal Tax: $76.25 Total Tax Paid: $87.50 ~~ VALID FROM OCTOBER 1, 1998 TO SEPTEMBER 30. 1999 RCPT #: OO1T014011 DATE: 9/14/1998 AMT: $87.50 ATTENTION - ""The Following Construction Contractors Require Additional Licensure'"** ALA.BIY1- __ ...... _.__. POOL ALUMINUM/VINYL RESIDENTIAL BUILDING ' ~ ROOFING ELECTRICAL ~ SHEET METAL SOLAR MECHANICAL PLUMBING IRRIGATION GENERAL CARPENTRY ~ WATER TREATMENT UNDERGROUND UTILITY HEATING AIR CONDITIONING - REFRIGERATION rn~s is an occupational license tax only. It doss not permit the Iitensee to violato any existing regulatory or zoning laws o! the County or City. Nar does it exempt the licensee from any other license or permit required by law. This is not a certification of the licensee's qualilication. ~ ^~ TAX COLLECTOR r Jan-22-99 03:24P GREENE-HAZEL & Associates 1 P.02 .. _~ .. .. x.~_ .....:._ ....w.. .. A`~D.r ~':i ~l/.~~ ~~~^',!!R~~ ~'L=~~; ~ ~~ : y+ ~ ,a~ ~:. ~ DASE (Yit~ODryTI. .. .. ..._...~.x~~.;...- .. ., ;. . w M ~ ..__:t~l .. ~.:~° . w. a r ~ • ' Y .t. : Vt...-r.Y::: ~ rm./W ..:::MwY Wy-l-::~ :: H:v ry.-x..v.~Y.: i v.ri~rx.a+.v ::~~'.v~'. os+oourxx ... r~M. : .. wn.w~w;~. THIS CERTIRCATE IS 1>SEUEO A8 A fiAATTER OF INFORir1ATION Greene-H8ze1 ~ A9sOCi8teD Inc Otit11 AND CONFERS FIO taIGHTS Ut~ON THE CERTIFCATE HOLDEq. THfB CERTIFICATE DOES NOT Aft1END, EXTEND OA 2301 Rivsrplace Hlvd, . 9t6 171.0 ALTER TFtt? COYERAOE AFFORDED BY THE fr~OLICIF.S BELOW. >,TSCjfSOllV3.lle, FL 3220"7 _S4kIPAN1E3 AFFORDING COVERAGE (904)398-1234 Fax (904)396-7432 CavANr • ~ Transcontinental Ins Co FRJMtD COMPANY - Peel Builders, Inc. a American Motorists Ina Co 437 Hawaiian Terzace coMaA,+Y ~ ~ • C Jacksonville FL 3221.6 ~,,,,,,Ir,Y - O _EIItA~ _ _ 1~'Oli ~~: - ~ _ _ .. V x ~~~ OF INSURANCE USSED THIS 1S TO CERTIFY THAT THE POUGES BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE fOR TNE POLICY PERIOD INDICATED. NOTWITHSTANDINp ANY REQUTAEJtAENT, TERAf OR CONDITION Of ANY CONTRACT OR OT-IER DOCU-JENT WITH RESPECT 70 WHICH THIS CEHTIRCATE MAY BE ISSUED OR MAY PERTAIN. THE INSUILWCE AtFORDED BY THE POLICIES DESCRIBED ttEREIN IS SUBJECT TO Ali THE TERMS. DfCLUSIONS AND CONDITIONS OF SUCH POLICIES. UMfT3 SHOWN MAY HAVE BEEN REDUCED BY PNO CLAIMS. I~TR ?Y9E OF MitIRAMC4 }Ot1CY NLMii01 !D ~Y OATtY (IgYDO/YY) ~~~ A c~~ L/°'~ et ~46oz1aa 0 5 / 01/ 9 8 O S / 0l/ 9 9 ~"E~ A°oREOATE step. CMaltna-1 OENERAI tueun r~NUCts - cprvpo A00 t ~ CtA.~a MADE ®OCCUn r~oNA1 a Aov worn ~_ ~ -~- AM+E/i'S a CONTRACTORS 1710T EACH Mf:CUARFlrCE 3 t,QQ,Q.~ _ FAE D.WAOE (My av h~) i _ A A"TD10f~ ~+""~T'' e t s5x~2e 0 5/ 0 1 / 9 8 0 5/ 01 / 9 9 A,-n AUTO I COWn+ED SWCXG IMAIT t1~000,000. ALL Ow~riD AUTOS BOOtiY wURY SCHEOutED AUT08 (9v p+~) = .~ rort¢D AvTos eoa~r worn HOwOwHeD AVTQ$ °a acaw+p ( i ' ~ ~ ' ~ vAOFw~v o~, uoe - . . I ~ woo= uAOUrY ~wto cxtr . O, AcaoalT s AHT AUTO Q T NEA THAN AUTO OM.Y: ' j' "" ~ EACH ACGOENT f V . AOOREOATC s EkCES! WCtRY EACH OCCIFAENCE i V~IEllA FORM AOOREOATI: _ OTHFJI THAN UM91ELU1 FORM ~• s• }3 Y+or~a COrFO+aAnON AMO ~g0 Ot606t-00 d 3/ O 1/ 9 8 d 3/ O 1/ 9 9 ~X TOftt Eiji ° R trwYSrr wsam ..... ... ~ EL EAa+ ACCIDENT : 1pp 000 pARCUT-+E IHCL r-~ El DISEJSE - PQICr LIMB . . . i ~~_ Or'FICD19 ARE iYCI 0. Ol9E/~9l! - EA E1AVL0YlE f QTMOI OE9C1tYTI0M OF 0~7U-YgNEtI,OCA rt[kb R$: BID 9899-10 ~y~. a-ar Mw y~~~ >LERTIFTCA~; l~.h~4^w'...Mwxxs++...-.~µniiw'~r.4w!.y~..u.u.+ ~..... ^;w .. y'a.!H.v~'-A..iN'~r ~fvr.xxV.`~~~y./~~ ,.y..~xJ.x n> .. ~ n ~Rt~xv~~n..,.r',r a. ~nr.a ~.. .. iY ~YSi.~.~. ~v....w ........ rrfw. xyx. f/. !~• ~1 .RA'E>t• x`. ~' Rat » ..... .v.. .. ............. .r-.nri~xx~ . ... w.w r sa M' :wd t! 'w t'.!!` ~ .. .. ....w v ... ..r . nr , ~ ~. ........r . . ..... ....:~...:....•..... .... :^::"?ii~vv . wr w ' nlout~ Awr os n+e ABOVE Desens-ED F'OtICE! se CArrceuia iEFOfI[ THE CZTY OF ATLANTIC BEACH E]VSaAT10M GAT$ T7t[MOF, THC asuNO eOMA7fT wit DlDewvpR to K~ 800 SEMINOLE ROAD ~'4. _ DAYS WwfiTTtM MOt1OE TO TNi CRTPICATC IW~Dfj1 MAI~'D TQ 7NE (FFT ATLANTIC BEACH, FL , avT sAU~ vo rrAa. weH MoT+ee wAU .~o.a .w wuoATVN wl uAaam OI AMY lf1fD UFOM T1f[ COIt-AM1, R1 AODR7< p A R vAE ~KfAT1VEd. ~~wiwrii:i6'C`w:si tier'? :. ::::::.f:~"'Y' ...»•~•• 4«..r.-~-- J1Y1ffOrll~ 111JA~ AT1Y~~ -~~`. .Y/`-' ~ (1 ~ ~ r.-x7`!l~r~•~+N:1 u-71""`~ ___ ..+~^-"`.w"~~+++.x`.+ ~y-3s:.M1,..s~-~• ~~.;..wm..w,,, - _.: i.~^. __ ~y.°f ~~.~ ~~~'^v:.:.~xvVil~~Ci~~a1.R7~~~~`~`